Constructs of the Child Behavior Checklist that predict treatment outcome in children with Oppositional Defiant Disorder

Abstract

Oppositional Defiant Disorder (ODD) is among the most commonly encountered clinical diagnosis in children and adolescents (American Academy of Child and Adolescent Psychiatry [AACAP], 2007). This study aims to improve the efficacy of treatment planning for children exhibiting symptoms of ODD in a day treatment setting by identifying child psychological factors related to treatment outcome. ^ The current study examines the utility of one the most commonly used assessment measures in clinical practice and research of children in psychology, the Child Behavior Checklist (CBCL) (Achenbach, 1991). It is possible that new clinical syndromes, such as 'pediatric mania' may explain ODD symptoms and lend strength to a biological model of ODD. Contrary to this notion, is a theory of childhood disruptive behavior which postulates that these symptoms stem from deeply engrained characterological traits that are persistent over time (Johnstone & Cooke, 2004). Yet another possible method for predicting treatment outcome in oppositional and defiant children examines comorbid presence of anxiety. All three of these child factors will be examined using the CBCL. ^ Since parenting has been identified as a primary factor in the formation and treatment of ODD, it is important to acknowledge the accompanying role of the parent in the treatment of severe ODD. How child psychological factors, including presence of 'pediatric mania,' and personality dysfunction, interact with parenting skills improvement and ODD symptoms is an extremely important consideration for the field of child psychology. ^ The archival data was drawn from the charts of 70 children, ages 5-8 years. These children had successfully completed either the 1st or 2nd grade at the Astor Day Treatment Program (Tilden site, Bronx New York). Data was collected from the Identifying Behavior Checklist (IBC), which was completed by the clinician every three months to assess symptom change. Information provided by the CBCL, which was completed by the parent on intake, includes indices of possible bipolar illness referred to as the 'Biederman profile,' characteristics of three personality disorders (Borderline, Narcisstic, and Antisocial), and levels of anxiety. ^ Results indicated that improvement of parenting skills was associated with decreases in oppositional symptoms, but more so for oppositional behavior at home rather than school. The Biederman profile was not found to be predictive of poor outcome for oppositional behavior or change in parenting skills. The three types of personality disorder characteristics were not found to be predictive of poor outcome for oppositional symptoms at school, but some significant associations were observed regarding oppositional treatment outcome at home. Particularly, Antisocial and Narcissistic Personality Disorder characteristics were found to be predictive of some indices of poor oppositional symptom change at home. Furthermore, Antisocial Personality Disorder characteristics were predictive of poor parenting skills treatment outcome in some respects. The findings of this study have significant implications for the field of School-Clinical Child Psychology. ^